Anemia is a significant co-morbidity in patients with heart failure (HF) irrespective of EF (EF) and is routinely quantified by hemoglobin concentration. Hemodilution as a cause of anemia has been described in systolic HF. This study aims to further investigate the effects of plasma volume in HF patients by 1) assessing prevalence of dilutional anemia in patients with anemia and a preserved EF and 2) exploring the relation between hemoglobin and red cell volume in these patients. Forty-six anemic patients (as determined by standard hemoglobin measurement): 22 with HF and low EFs (HFLEF) and 24 with HF and a preserved EFs (HFPEF) all underwent plasma volume measurement with I-131 labeled albumin. Hemoglobin values did not differ between subjects with HFLEF and HFPEF (10.8±1.0 vs. 11.0±1.0 gm/dl, p=0.55) but a red cell deficit was found in 88% of patients with HFPEF as compared with 59% of HFLEF (p=0.04). This was the result of a higher prevalence of an expansion of plasma volume in HFLEF patients (100%) as compared with HFPEF patients (71%). Among all patients, no correlation was found between hemoglobin and red cell volume (r = 0.09, p=0.54), but a correlation did exist among patients with normal blood volumes (r=0.55, p = 0.02). In conclusion, dilutional anemia resulting from an expansion in plasma volume without a red cell deficit occurs more commonly in HFLEF than HFPEF patients and hemoglobin does not correlated with red cell volume in anemic HF patients.

We examined relationships of central adiposity with left ventricular (LV) diastolic dysfunction in men and women who participated in the Baltimore Longitudinal Study of Aging, a prospective community-based study of older persons. The sample for this cross-sectional analysis included 399 women and 370 men. Central adiposity was estimated by waist circumference (WC) and global adiposity by body mass index (BMI). Using data from a comprehensive echocardiographic study that included tissue Doppler imaging, diastolic function was graded according to three parameters (E/A ratio, E/Em ratio and left atrial volume index). In logistic regression models adjusted for age, gender, cardiovascular risk factors and hemodynamic parameters, WC and BMI were both independently associated with LV diastolic dysfunction. However, when both WC and BMI were in the same model, only WC remained significantly associated with LV diastolic dysfunction (OR= 1.04, 95% CI: 1.01 to 1.08, p= 0.02). In gender stratified analyses, WC was found significantly associated with LV diastolic dysfunction - independently of BMI - in women (OR=1.08, 95% CI: 1.04 to 1.14, p<.001) but not in men (OR= 1.00, 95% CI: 0.95 to 1.05, p= 0.91). Further adjustment for left ventricular mass index failed to modify these relations. In conclusion, the adverse effect of central adiposity on LV diastolic function was independent of general adiposity and more pronounced among women. The impact of visceral adiposity on LV diastolic dysfunction would benefit from confirmation in longitudinal studies.

The coronavirus disease (COVID)-19 pandemic has affected millions worldwide with prevention efforts culminating in the development of a vaccine. An mRNA vaccine, developed by Moderna (Cambridge, MA, USA), mounts an immunologic response leading to antibody neutralization. Commonly reported vaccine side effects include myalgia, fever, and chills, with low reported rates of cardiovascular events. This case demonstrates the development of takotsubo syndrome (TTS) after administration of the COVID-19 vaccine. A 73-year-old woman with recently diagnosed myocardial infarction with no obstructive coronary atherosclerosis (MINOCA) presented with typical chest pain starting less than a day after receiving the Moderna vaccine. She had troponin elevations and new ST-segment abnormalities. Transthoracic echocardiogram (TTE) findings were consistent with mid-ventricular TTS. Treatment included diuretics, beta-blockers, and angiotensin receptor blockers. Prior to discharge, repeat imaging showed improvement in systolic function. This case presents a post-menopausal woman with a recent diagnosis of MINOCA who developed TTS shortly after receiving the COVID-19 vaccine. Risk factors including sex, age, MINOCA, anxiety about the vaccine, and possibly the vaccine itself may have all contributed to the TTS presentation. TTS may occur after COVID-19 vaccination, and appreciation of this potential rare association is important for evaluating vaccine safety and optimizing patient outcomes.

United Network for Organ Sharing (UNOS) updated the heart transplant allocation system in 2018 in an effort to improve waitlist times and better prioritize the sickest candidates. The new allocation system added new statuses 1 through 3 at the top of the waitlist in place of former status 1A, with temporary mechanical support (MCS) including extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), and other temporary ventricular and biventricular support associated with the highest two statuses. 1 Other common listing strategies such as high-dose inpatient inotrope use and durable ventricular assist devices (LVAD) became statuses 3 and 4, respectively. Early experiences with the impact of the new allocation system identified an increase in temporary MCS (predominantly IABP) and variable effects on post-transplant survival. [2][3][4][5][6] However, there are limited data about the effects of the new allocation system on waitlist outcomes, 3,6 and specifically, the effects on waitlist outcomes stratified by various transplant listing strategies. Ongoing updates to the UNOS dataset allow for additional follow-up time and analyses of waitlist outcomes based on listing strategy. These